CMS has announced it will launch demonstration programs beginning in January 2012 targeting some of the most common factors that lead to improper payments.
Cost Saving Projects will Help Protect Medicare and Medicaid:
Beginning on Sun Jan 1, 2012, CMS will conduct demonstration projects that will strengthen Medicare by aiming at eliminating fraud, waste, and abuse. Reductions in improper payments will help ensure the sound future of the Medicare Trust Fund and protect Medicare beneficiaries who depend upon it such as:
Recovery Audit Prepayment Review
Prior Authorization for Certain Medical Equipment
Part A to Part B Rebilling
New Projects Build on 2011 Savings:
The 2012 projects announced will build on accomplishments in 2011 to reduce Medicare and Medicaid improper payment rates. CMS is also reporting for the first time a composite improper payment rate for the Medicare Part D prescription drug program. The improper payment rate for the Children’s Health Insurance Program (CHIP) will not be published until 2012. While improper payment rates are not necessarily an indicator of fraud in Medicare, Medicaid or CHIP, they do provide HHS, CMS and States with a more complete assessment of factors leading to error rates and new ways to help prevent them. CMS is continuing to invest time and resources to work with providers across the country and eliminate errors through increased and improved training, education, and outreach.
The full CMS Fact Sheet issued is available here: http://www.CMS.gov/apps/media/press/factsheet.asp?Counter=4176.
CMS Prior Auth Fact Sheet – https://www.CMS.gov/apps/media/press/factsheet.asp?Counter=4168
CMS Rebilling Fact Sheet – http://www.CMS.gov/apps/media/press/factsheet.asp?Counter=4169
CMS Recovery Audit (RAC) Demo Fact Sheet – http://www.CMS.gov/apps/media/press/factsheet.asp?Counter=4170